Assessing tumor response to neoadjuvant chemoradiation in rectal cancer with rectoscopy and 18F-FDG PET/CT: results from a prospective series

• Víctor López-López ^[1] ; Jesús Abrisqueta Carrión ^[1] ; Juan Luján ^[1] ; Patricio B. Lynn ^[2] ; Laura Frutos ^[1] ; Akiko Ono ^[1] ; Eduardo Ortiz ^[1] ; José J. López-Espín ^[3] ; José Gil ^[1] ; Pascual Parrilla ^[1]
  1. [1] Hospital Virgen de la Arrixaca

     Hospital Virgen de la Arrixaca

     Murcia, España

     
  2. [2] New York University

     New York University

     Estados Unidos

     
  3. [3] Universidad Miguel Hernández. Elche, Alicante. Spain

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• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 113, Nº. 5, 2021, págs. 307-312
• Idioma: inglés
• DOI: 10.17235/reed.2020.6954/2020
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• Resumen

  • Introduction: rectoscopy and 18F-FDG PET/CT as a diagnostic algorithm for the assessment of tumor response in rectal cancer after neoadjuvant chemoradiation therapy (CRT) is very useful. Material and methods: this was a prospective longitudinal study in patients with locally advanced rectal cancer treated with neoadjuvant CRT. Patients were assessed after CRT completion with a digital rectal examination, proctoscopy and 18F-FDG PET/CT. Patients were subdivided as clinical (cCR) or radiologic (rCR) responders and non-responders according to tumor response. Clinical and radiological re-assessment was compared with the surgical specimen. Pathological tumor regression (pCR) grade was determined according to Mandard’s classification. Of the 68 patients included, 15 (22 %) presented pCR in the surgical specimen and tumor persistence (non-PCR) was detected in the remaining 53 (78 %). Clinical assessment (DRE+ rectoscopy) identified 15 patients as cCR and 53 as non-cCR, two were false positives and two were false negatives. The overall accuracy was 94 %. 18F-FDG PET/CT identified 18 patients as rCR and 50 as non-rCR, one was a false positive and four were false negatives. The overall accuracy was 92 %. A combination of clinical findings and 18F-FDG PET/CT resulted in an accuracy of 96 %. The combination of clinical findings + 18F-FDG PET/CT was able to correctly identify all cases of pCR, with the exception of one case that presented a tumor regression of 80 %. In this series, 18F-PET-CT and clinical assessment had excellent accuracies in differentiating PCR from non-PCR after CRT completion. PET-CT combined with clinical assessment had a better accuracy than both modalities independently. 18F-FDG PET/CT is a valid tool that complements the clinical assessment of tumor response